Spiritual perspectives, needs and nursing interventions of Christian African-Americans

Spirituality and Spiritual Care in Nursing: Validity of the Spirituality and Spiritual Care Rating Scale in an Indian Context

This study was undertaken to test the validity of the Spirituality and Spiritual Care Rating Scale (SSCRS) by McSherry et al. (IJNS 39:723-734, 2002) in an Indian context. The study was conducted in a tertiary care teaching hospital with a convenience sample of 200 nurses. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were completed to assess the reliability and validity of the tool. The results of the present study were similar to but differed from the McSherry et al's (IJNS 39:723-734, 2002) study which identified 17 items on the scale. Only 15 items loaded on three factors.

Adaptation and psychometric evaluation of the Chinese version of the functional assessment of chronic illness therapy spiritual well-being scale among Chinese childhood cancer patients in China

Background

Spiritual well-being is a strength for childhood cancer patients to cope with cancer. The availability of a valid and reliable instrument for assessing spiritual well-being is crucial. This study translated and adapted the Functional Assessment of Chronic Illness Therapy Spiritual Well-being scale (FACIT-Sp) for Chinese childhood cancer patients and examined the psychometric properties and factor structure in this population.

Methods

This was a methodological study. The FACIT-Sp was translated into Chinese. Adaptation was based on our qualitative study. For psychometric evaluation, a convenience sample of 412 were recruited based on the suggested sample size for the exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Childhood cancer patients were included if they aged 8-17 years, with parental consent to participate, able to communicate that they were being treated for cancer, and able to communicate and read Chinese. Participants answered the Chinese version of the adapted FACIT-Sp, the Center for Epidemiology Studies Depression Scale for Children (CES-DC), and the Pediatric Quality of Life Inventory 3.0 Cancer Module (PedsQL). Content validity, convergent validity, internal consistency and test-retest reliability were examined. Both EFA and CFA assessed the structural validity of the adapted FACIT-Sp.

Results

The content validity index values for items ranged 0.8-1.0 and that for the scale was 0.84, indicating appropriate content validity. The scale had good internal consistency, with a Cronbach's alpha of 0.815. The FACIT-Sp scores positively correlated with the CES-DC scores, and negatively correlated with PedsQL scores, suggesting that the Chinese version of the adapted FACIT-Sp had reasonable convergent validity. EFA yielded a four-factor (meaning, peace, faith, and connection with others) model. The CFA results revealed that the four-factor model achieved a better fit than the original three-factor model (Chi-Square Mean/Degree of Freedom = 2.240 vs. 3.557, Comparative Fit Index = 0.953 vs. 0.916, Goodness of Fit Index = 0.909 vs. 0.884, Root Mean Square Error of Approximation = 0.078 vs. 0.112).

Conclusion

The Chinese version of the adapted FACIT-Sp is a reliable and valid instrument for assessing spiritual well-being among Chinese childhood cancer patients. This instrument can be applied in clinical settings for routine assessment.

A Descriptive and Phenomenological Exploration of the Spiritual Needs of Chinese Children Hospitalized with Cancer

Spiritual well-being is the fourth dimension of health, as equally important as physical, mental, and social well-being. The shadow of death associated with cancer triggers children to explore their personal values, meanings, and life goals throughout the illness trajectory, enabling them to identify their unique spiritual needs. Chinese children are generally non-religious, unlike Western children, which affects their spiritual needs. To address the literature gaps, we applied a qualitative, descriptive, phenomenological approach for exploring the spiritual needs of Chinese children hospitalized with cancer. Purposive sampling was conducted in two public hospitals with special wards for pediatric oncology patients in Hunan Province, China. Consequently, 22 children, hospitalized with cancer, were recruited and individually interviewed using a semi-structured interview format. We conducted a thematic analysis of the interview transcripts. Four important themes were identified: the need for self-exploration, inner needs, need for a connection with others, and need for a connection with gods, supernatural powers, and fictional characters. We found that culture significantly influenced the spiritual needs of Chinese children with cancer. Hope was a key factor motivating the children to continue cancer treatment. To address their unique spiritual needs, culturally specific interventions should be developed and incorporated into their care to enhance their spiritual well-being.

Traditionality, Spirituality and Somatoform Dissociation Symptoms in Chinese Buddhists

To evaluate the relationship between spiritual experience and hysterical experiences in Buddhist participants in ethnic groups in China, this cross-sectional study recruited 39 participants aged 16-57 years old, and self-administered surveys were administered in two villages, one city and one town by four research assistants in the Inner Mongolia and Qinhai areas. Binary logistic regression analyses were used to evaluate the factors associated with somatoform dissociation symptoms. Surveys were completed by 639 participants (mean age 31 years; 54.6% females) in 2017. Binary regression models showed that diverging from tradition and having a college education or above were associated with suffering from somatoform dissociation symptoms. By contrast, participants with higher experiences and older people were less likely to experience somatoform dissociation symptoms. Our current research highlights the contribution of spiritual experiences and traditional values to reducing somatization dissociation symptoms, and the findings could help to promote a new relationship between psychiatry and spiritual experiences that will benefit both mental health professionals and those who seek their assistance.

A Faith-Based Intervention to Improve Hypertension Management Among African Americans

High mortality rates continue among African Americans related to complications of uncontrolled hypertension. The purpose of this study was to determine if a faith-based self-management education program would improve self-care activities related to the management of hypertension among African American adults. Ten African American adults who reported a diagnosis of hypertension for 6 months or longer completed an 8-week education program focused on strategies for hypertension management. The education program was enhanced with the utilization of spiritual components of prayer, Scripture reading, and journaling.

Patient Perspectives about Spirituality and Spiritual Care

Objective:

This study was undertaken to explore the perspectives regarding spirituality and spiritual care held by individuals with advanced disease. The aim was to gain a deeper understanding about their viewpoints surrounding spiritual care and the role of health-care professionals in providing such care.

Methods:

Sixteen individuals with advanced disease and a prognosis of <12 months underwent an in-depth interview. Transcripts were subjected to a qualitative descriptive analysis to identify salient content and themes.

Results:

Four overall themes were identified: Spirituality is personal, spiritual distress is about separation, spiritual care is about connecting, and conversations about spirituality must align with the patient's beliefs. Subthemes emphasized the individuality of spiritual expression, the potential for illness impacting spiritual beliefs, and the value of connections to one's spiritual community. Participants thought healthcare providers needed to be able to identify individuals who were experiencing a spiritual struggle, acknowledge the reality of that struggle, and connect the individual with the appropriate resource or person.

Conclusions:

Patients with advanced disease are likely to express their spirituality in unique ways. Being able to talk about their spiritual beliefs and doubts during illness without judgment was seen as a benefit to them. Healthcare providers ought to be able to identify those patients who require assistance in connecting to appropriate spiritual care resources.

Is There More to Resourcefulness Than Personal and Social Skills?

This study examined relationships among personal and social resourcefulness and spiritual practices and their associations with perceived stress, depressive symptoms, and self-assessed health in 138 women caregivers of elders with dementia. Caregivers who rated high on personal and social resourcefulness and spiritual practices (by median splits) had the lowest perceived stress, fewest depressive symptoms, and best self-assessed health, followed in sequence by women rating high on two of the three, high on one of the three, and low on all three. Hierarchical regression analyses that introduced spiritual practices after resourcefulness showed significant increases in the R-square change by 3% and 5% for perceived stress and depressive symptoms, respectively, but no significant change for self-assessed health. Strong associations among personal and social resourcefulness and spiritual practices, and similar relationships with two health outcomes, suggest that spiritual practices may be a third dimension of resourcefulness.

Spirituality and Religion among the General Public: Implications for Social Work Discourse

Conceptualizations play a central role in social work discourse, shaping actions in the areas of practice, research, and education. Although many formulations of spirituality and religion have been advanced by social work scholars, the views of members of the general public have been largely absent from the professional conversation. The present article adds to the profession's evolving discussion on spirituality and religion by describing common understandings of spirituality and religion among the general population and by discussing the implication of these views for social work discourse on spirituality and religion. By understanding common views among the public, the social work profession is better positioned to provide ethical and professional services that respect clients' spiritual beliefs and values.

Failure to address African Americans' spiritual needs during hospitalization: identifying predictors of dissatisfaction across the arc of service provision

Using a national sample of recently hospitalized older African Americans (N = 2,227), this study identified predictors of dissatisfaction with the manner in which clients' spiritual needs were addressed during hospitalization. Of 8 major areas of service provision examined, 3 were significant predictors of dissatisfaction: nurses, physicians, and the discharge process. The findings underscore the importance of collaborative efforts to address elderly Black clients' spiritual needs. Social workers, who frequently oversee the discharge process, can play an important role in addressing African Americans' spiritual needs by developing discharge plans that incorporate clients' spiritual strengths and resources into the planning process.

African Americans' Culturally Specific Approaches to the Management of Diabetes

Spirituality is an important multidimensional cultural resource and coping strategy used by many African Americans for managing chronic diseases such as diabetes. Yet, few studies examine meaning and interpretation of colloquial terms frequently used for coping within the context of a community culture. We designed an interpretive qualitative study to gain a deeper understanding of a colloquial phrase, "I ain't claiming it," used among Project SuGar research participants when discussing diabetes. Thematic analysis revealed two major themes, Acknowledgment and Denial, as coping mechanisms through an active or passive relationship with God. Sub-theme of acknowledgment was presented as front seat driver and sub-theme for denial of the disease presented as back seat driver. These meanings encompass a range of culturally specific coping strategies for self-management that health providers should consider and implement as part of providing patient-centered care to enhance better outcome strategies.

Addressing the spiritual needs of American Indians: predictors of satisfaction

Spirituality is instrumental to health and wellness in many American Indian (AI) cultures. Although the Joint Commission requires spiritual assessments to identify and address clients' spiritual needs during hospitalization, little is known about the operationalization of this process for American Indians (AIs). To address this gap in the literature, the present study employed a national sample of AIs (N = 1,281) to identify predictors of satisfaction with the manner in which their spiritual needs were addressed. The results suggest the discharge process, physicians, room quality, and nurses play important roles in satisfactorily addressing AIs' spiritual needs. Of these, the discharge process had the largest effect on satisfaction, underscoring the salience of social workers in addressing the spiritual needs of hospitalized AIs.

Development and Psychometric Testing of Two Tools to Assess Nurse Practitioners’ Provision of Spiritual Care

Purpose: The purpose of this study was to develop and evaluate the psychometric properties of two tools measuring the frequency nurse practitioners (NPs) assess for spiritual need and provide spiritual interventions. Spiritual care provided by NPs has the potential to improve health indicators without increasing costs. Design: Survey design Methods: Concept analysis of the literature supported each item developed for the new assessment and intervention tools. Content validity was tested with six subject matter experts using Lawshe’s method of content validity ratios (CVR). Inter-item correlations further supported convergent and divergent validity of the items with 133 practicing NPs. Cronbach’s alpha supported internal consistency of the tools and subscales. Findings: CVR analysis provided data supporting revision of the original tools. Convergent and divergent validity were also supported for each item. Both the assessment and intervention tools had high Cronbach’s alpha’s that met the required 0.70 for the entire scale and subscales. Conclusions: Both tools and their subscales showed evidence of validity and reliability. Continued research to refine the tools is needed. Implications: The tools can be valuable for assessing NP practice regarding spiritual care within relationship-based and patient centered care.

The Spiritual Needs of Ailing Hospitalized Patients: An Integrative Review

La espiritualidad es intrínseca al ser humano y se manifiesta también asociada a la enfermedad, la pérdida o cuando el ser humano se enfrenta con el sufrimiento o la muerte. Como la expresión de las necesidades espirituales no se procesa de igual forma en la per- sona sana o enferma, su atención requiere una intervención rigurosa y profesional. Objetivos: identificar necesidades espirituales de la persona hospitalizada y conceptos de espiritualidad. Método: revisión integrativa de diez estudios cuantitativos y cualitativos sobre necesidades espirituales, publicados en el período del 2004 al 2011 en las bases de datos (EBSCO, MEDLINE, SAGE y B-ON), orientada por las interrogantes: ¿Cuáles son las necesidades espirituales de la persona hospitalizada y los conceptos de espiritualidad utilizados en los estudios seleccionados? Resultados: del análisis de los artículos emergieron las siguientes necesidades espirituales: busca de sentido en la enfermedad y sufrimiento; estar en relación con los otros y con el Ser Superior, lo que señala presencia evidente de valores, creencias espirituales, fe, esperanza y necesidades religiosas, asociadas a los conceptos: sentido de vida, relaciones, transcendencia y prácticas religiosas. Conclusiones: los enfermos pueden expresar sus necesidades espirituales por medio de las formas más sutiles. Los enfermeros deben evaluar las necesidades espirituales de “mente abierta” y ser capaces de proporcionar la asistencia más adecuada.

Hospitalized Asian patients and their spiritual needs: developing a model of spiritual care

OBJECTIVES

A paucity of research has examined the relationship between addressing the spiritual needs of hospitalized Asians and their overall satisfaction with service provision. This study examined this relationship, in tandem with the effects of eight potential mediators, to develop a model of spiritual care for older hospitalized Asians.

METHOD

Structural equation modeling was used with a national sample of Asians (N = 805), age 50 and above, who were consecutively discharged from hospitals over a 12-month period.

RESULTS

The relationship between spiritual needs and satisfaction was fully mediated by five variables: nurses, physicians, the discharge process, visitors, and the admissions process.

DISCUSSION

As the first study to develop and test a model of spiritual care for older hospitalized Asians, the findings provide practitioners with the information to target their efforts on the most important organizational areas that facilitate more effective, culturally relevant service delivery to members of this population.

Addressing Spiritual Needs and Overall Satisfaction With Service Provision Among Older Hospitalized Inpatients

Little research has examined the relationship between addressing older adults’ spiritual needs and overall satisfaction with service provision during hospitalization, despite the importance of spirituality and religion to most older adults. This study examined this relationship, in tandem with the effects of eight potential mediators. Toward this end, structural equation modeling was used with a sample of 4,112 adults age 65 and older who were consecutively discharged over a 12-month period from hospitals in California, Texas, and New England. As hypothesized, addressing spiritual needs was positively associated with overall satisfaction. The relationship between spiritual needs and satisfaction was fully mediated by seven variables: nursing staff, the discharge process, visitors, physicians, the admissions process, room quality, and the administration of tests and treatments. The diverse array of mediating pathways identified highlights the importance of health care practitioners working collaboratively to address older adults’ spiritual needs.

Spirituality measurement in African American cancer survivors: a critical literature review

PURPOSE

Spirituality is a mechanism that supports coping with chronic illnesses such as cancer, and has been frequently used in the African American (AA) population. Measures of spirituality are needed, which are culturally sensitive, appropriate, and psychometrically sound.

DESIGN

A critical literature review was performed to identify instruments measuring spirituality as a response to illness.

METHOD

Whittemore and Knafl's method was used to search pertinent databases for instrumentation assessing spirituality and its applicability in AA cancer survivors.

FINDINGS

In all, 13 research articles detailing nine instruments were obtained and included for analysis. Of the nine instruments, only two (Perspectives of Support From God Scale and Connections to God Scale) were psychometrically tested in populations of AAs who had completed primary treatment for their cancer. Cultural validity was tested in only the Perspectives of Support From God Scale, showing a deficit in the assessment of cultural appropriateness of these instruments to the population.

CONCLUSIONS

Further research is needed to confirm validity of these measures. Cognitive pretesting and assessment of cross-cultural validity can be used to ensure proper understanding of terminology and avoid potential biases. Repeated testing of the instrument in the desired population is necessary to confirm that constructs and items are understood and cognitively processed as intended.

Student nurses' perspectives of spirituality and spiritual care

AIM

To investigate nursing students' perceptions of spirituality and spiritual care.

BACKGROUND

Spirituality is an essential part of holistic care but often neglected in practice. Barriers to spiritual care include limited educational preparation, negative attitudes towards spirituality, confusion about nurses' role, perceptions of incompetence and avoidance of spiritual matters. There is limited knowledge about students' perspectives of spirituality and spiritual care. Previous studies have predominantly focused on educational approaches to enhance spirituality. The next generation of clinicians may have different worldviews, cultural beliefs and values about spirituality and spiritual care from current nurses. There is a need to understand students' views and how their spiritual development is shaped in order to inform pre-registration education.

METHOD

A cross-sectional survey of final-year students from three educational institutions in Singapore was conducted from April to August 2010. Data included demographic details and responses on a new composite tool, the Spiritual Care Giving Scale (SCGS).

RESULTS

A response rate of 61.9% (n=745 out of 1204) was achieved. The lowest mean score was item 9, "Without spirituality, a person is not considered whole". Highest mean was item 2, "Spirituality is an important aspect of human being". Factor 5 (Spiritual Care Values) had the lowest mean with Factor 2 (Spirituality Perspectives) the highest. Participants considered spirituality as essential to being human; developmental in nature; and vital for individuals' state of well-being. Attributes important for spiritual care were identified. Multivariate analyses showed positive association between participants' scores and institution but not with other variables.

CONCLUSION

Participating student nurses reported a high level of spiritual awareness that was not constrained by age. Students affirmed the importance of spiritual awareness in order to address the spiritual needs of patients. There was some congruence between the perceptions of students in this ethno-culturally diverse Asian sample and responses by students in the UK and North America on the personal attributes needed to provide spiritual care. Comparative studies using the SCGS could inform our understanding of spirituality and best pedagogical approaches to develop spiritual awareness across the curricula and in clinical practice.

American indians and spiritual needs during hospitalization: developing a model of spiritual care

PURPOSE

Although spirituality is typically intertwined with health in Native cultures, little research has examined the relationship between American Indians' spiritual needs and overall satisfaction with service provision during hospitalization. This study examined this relationship, in tandem with the effects of 8 potential mediators, to develop a model of spiritual care for older hospitalized American Indians.

DESIGN AND METHODS

Structural equation modeling was used with a sample of American Indians (N = 860), aged 50 and older, who were consecutively discharged from hospitals across the United States over a 12-month period.

RESULTS

As posited, addressing spiritual needs was positively associated with overall satisfaction with service provision. The relationship between spiritual needs and satisfaction was fully mediated by 4 variables: nursing staff, the discharge process, physicians, and visitors.

IMPLICATIONS

As the first study to develop and test a model of spiritual care for older hospitalized American Indians, this study provides practitioners with the information to provide more effective, culturally relevant services to older American Indians.

Spirituality as experienced by Muslim oncology nurses in Iran

Spirituality, as an essential part of holistic care, is concerned with faith and meaning, and is usually conceptualised as a 'higher' experience or a transcendence of oneself. A resurgence of interest in this area is evident in post modern culture because of the effects that spirituality and religious beliefS may have on health. Up until the last two decades, spirituality and spiritual care, although vital, were invisible aspects of nursing. However, now that these concepts have made their way into the mainstream, literature in this area has burgeoned. In addition, modern nursing grew out of spiritual roots, and spiritual care is a component of holistic care. In the Islamic Republic of Iran,little information exists documenting the expressed spirituality of nurses in general and of oncology nurses in particular. This article presents spirituality as it is experienced by Muslim oncology nurses.The investigation involved a qualitative analysis of the spirituality of 24 participants, using semi-structured interviews. Participants were oncology nurses at 12 hospitals in two educational universities of medical sciences in Tehran. The main categories of spirituality as experienced by oncology nurses included religious and existential dimensions in an Iranian Muslim context. Findings are consistent with the holistic view of Islam, that considers all dimensions of personhood simultaneously. This study is important to transcultural nursing because of the benefits of increasing nursing knowledge through research that examines nurses' spirituality in diverse cultures.

Development of a Spiritual Self-Care Practice Scale

Background and Purpose: Development of a valid, reliable instrument to measure spiritual self-care practices of patients with heart failure. Methods: African American patients (N = 142) with heart failure participated in the study. Spiritual advisors from several religious groups reviewed the Spiritual Self-Care Practices Scale (SSCPS) for content validity. Construct validity was determined using a principal components factor analysis. Reliability was established using Cronbach’s alpha coefficients. Results: Religious advisors provided suggestions to improve content validity. Four factors consistent with spiritual practices (personal spiritual practices, spiritual practices, physical spiritual practices, and interpersonal spiritual practices) emerged from the factor analysis. The alpha coefficient was moderate at 0.64. Conclusions: Results indicated the SSCPS was reliable and valid for measuring spiritual self-care practices among African Americans with heart failure. Additional testing is needed to confirm results in other patient groups with chronic illnesses.

Acute care nurses' spiritual care practices

The purpose of this study was to identify barriers in providing spiritual care to hospitalized patients. A convenience sample (N = 271) was recruited at an academic medical center in New York City for an exploratory, descriptive questionnaire. The Spiritual Care Practice (SCP) questionnaire assesses spiritual care practices and perceived barriers to spiritual care. The SCP determines the percentage that provides spiritual support and perceived barriers inhibiting spiritual care. The participation rate was 44.3% (N = 120). Most (61%) scored less than the ideal mean on the SCP. Although 96% (N = 114) believe addressing patients spiritual needs are within their role, nearly half (48%) report rarely participating in spiritual practices. The greatest perceived barriers were belief that patient's spirituality is private, insufficient time, difficulty distinguishing proselytizing from spiritual care, and difficulty meeting needs when spiritual beliefs were different from their own. Although nurses identify themselves as spiritual, results indicate spirituality assessments are inadequate. Addressing barriers will provide nurses opportunities to address spirituality. Education is warranted to improve nurses' awareness of the diversity of our society to better meet the spiritual needs of patients. Understanding these needs provide the nurse with opportunities to address spirituality and connect desires with actions to strengthen communication and the nurse-patient relationship.

I'm a Jesus girl: coping stories of Black American women diagnosed with breast cancer

Breast cancer continues to be the most diagnosed cancer for all women, excluding non-melanoma skin cancer, in the United States. Incidence rates are 1 in 8 for an American woman being diagnosed. Moreover, statistics indicate that every 13 min an American woman dies from complications related to breast cancer. Despite all the gains made in the area of cancer research, Black American women continue to have a 67% higher mortality rate than their White counterparts. There is no preparation for a diagnosis of breast cancer. Upon hearing the words: you have breast cancer, a woman's life is forever altered. The woman's initial reactions of denial and/or anger yield to strategic responses. These responses may strengthen the woman's resiliency both during and following treatments. Research indicates that Black Americans, specifically Black American women, exhibit greater religiosity/spirituality than do other racial/ethnic groups. In addition, the use of religiosity/spirituality by Black Americans increases during a crisis. This qualitative study examines how religiosity/spirituality was utilized as a coping mechanism by a group of Black American women following their diagnoses of breast cancer.

Spiritual expressions of African Americans and Whites in cancer pain

BACKGROUND

Spiritual practices are one way that individuals cope with cancer pain.

PURPOSE

Describe and contrast expressions and values about the use of spirituality for pain in African American (AA) and White (WH) oncology patients.

METHODS

Six groups (3 AA; 3 WH; n=42; mean age 58) were conducted. Focus group and qualitative methodology with a cultural interpretive lens was utilized. The Model of Integrated Spirituality provided the conceptual framework for understanding the narratives.

FINDINGS

AAs and WHs did not differ on demographics, pain status, or integrative therapies. Three spirituality themes emerged: 1) pain and distress as antecedents to the use of spirituality; 2) active and existential attributes of the use of spirituality; and 3) mobilization of internal and external resources as outcomes. There were commonalities between AAs and WHs but greater frequency of certain subthemes and keywords in AAs.

CONCLUSIONS

Future studies should examine whether differences in overt expressions translate into different types and levels of spiritual usage.

IMPLICATIONS FOR PRACTICE

Clinicians should recognizing similar as well as different uses and descriptions of spirituality between African Americans and Whites.

A psychometric evaluation of measures of spirituality validated in culturally diverse palliative care populations

CONTEXT

Despite the need to accurately measure spiritual outcomes in diverse palliative care populations, little attention has been paid to the properties of the tools currently in use.

OBJECTIVES

This systematic review aimed to appraise the psychometric properties, multifaith appropriateness, and completion time of spiritual outcome measures validated in multicultural advanced cancer, HIV, or palliative care populations.

METHODS

Eight databases were searched to identify relevant validation and research studies. A comprehensive search strategy included search terms in three categories: palliative care, spirituality, and outcome measurement. Inclusion criteria were: validated in advanced cancer, HIV, or palliative care populations and in an ethnically diverse context. Included tools were evaluated with respect to psychometric properties (validity, reproducibility, responsiveness, and interpretability), multifaith appropriateness, and time to complete.

RESULTS

A total of 191 articles were identified, yielding 85 tools. Twenty-six tools (representing four families of measures and five individual tools) met the inclusion criteria. Twenty-four tools demonstrated good content validity and 12 demonstrated adequate internal consistency. Only eight tools demonstrated adequate construct validity, usually because specific hypotheses were not stated and tested. Seven tools demonstrated adequate test-retest reliability; two tools showed adequate responsiveness, and two met the interpretability criterion. Data on the religious faith of the population of validation were available for 11 tools; of these, eight were tested in multifaith populations.

CONCLUSION

Results suggest that, at present, the McGill Quality of Life Questionnaire, the Measuring the Quality of Life of Seriously Ill Patients Questionnaire, and the Palliative Outcome Scale are the most appropriate multidimensional measures containing spiritual items for use in multicultural palliative care populations. However, none of these measures score perfectly on all psychometric criteria, and their multifaith appropriateness requires further testing.

The measurement of spirituality in palliative care and the content of tools validated cross-culturally: a systematic review

CONTEXT

Despite the need to assess spiritual outcomes in palliative care, little is known about the properties of the tools currently used to do so. In addition, measures of spirituality have been criticized in the literature for cultural bias, and it is unclear which tools have been validated cross-culturally.

OBJECTIVES

This systematic review aimed to identify and categorize spiritual outcome measures validated in advanced cancer, human immunodeficiency virus (HIV), or palliative care populations; to assess the tools' cross-cultural applicability; and for those measures validated cross-culturally, to determine and categorize the concepts used to measure spirituality.

METHODS

Eight databases were searched to identify relevant validation and research studies. An extensive search strategy included search terms in three categories: palliative care, spirituality, and outcome measurement. Tools were evaluated according to two criteria: 1) validation in advanced cancer, HIV, or palliative care and 2) validation in an ethnically diverse context. Tools that met Criterion 1 were categorized by type; tools that also met Criterion 2 were subjected to content analysis to identify and categorize the spiritual concepts they use.

RESULTS

One hundred ninety-one articles were identified, yielding 85 tools. Fifty different tools had been reported in research studies; however, 30 of these had not been validated in palliative care populations. Thirty-eight tools met Criterion 1: general multidimensional measures (n=21), functional measures (n=11), and substantive measures (n=6). Nine measures met Criterion 2; these used spiritual concepts relating to six themes: Beliefs, practices, and experiences; Relationships; Spiritual resources; Outlook on life/self; Outlook on death/dying; and Indicators of spiritual well-being. A conceptual model of spirituality is presented on the basis of the content analysis. Recommendations include consideration of both the clinical and cultural population in which spiritual instruments have been validated when selecting an appropriate measure for research purposes. Areas in need of further research are identified.

CONCLUSION

The nine tools identified in this review are those that have currently been validated in cross-cultural palliative care populations and, subject to appraisal of their psychometric properties, may be suitable for cross-cultural research.

Healthcare needs of noninstitutionalized Jordanian cancer patients: an exploratory descriptive study

Despite all advances in healthcare, provision of healthcare for cancer patients remains one of major continuing challenges for healthcare professionals. One of these challenges is shorter hospital stay. In this fast-paced environment, identification of cancer patients' needs is limited yet necessary to initiate an appropriate treatment plan for this group of patients. The major purpose of this study was to identify healthcare needs of noninstitutionalized patients with cancer from Arab Jordanians' perspective. The study was conducted at a chemotherapy clinic of a major university hospital in Jordan. An exploratory descriptive design using a structured interview was used to collect the data. The questions of the interview composed of items of several scales including the Patient Need Scale. Sixty-two participants met the inclusion criteria and agreed to participate. The participants were patients with cancer, were receiving chemotherapy, and were (a) Jordanian male or female patients, (b) able to communicate in Arabic, (c) 19 years of age or older, and (d) free from psychiatric or mental illnesses. Participants reported 70 existing needs (68.6%). However, 50% of these identified needs were perceived as being not met. Jordanian patients with cancer reported more healthcare needs than patients in Western cultures. Individualized comprehensive assessment of patients' needs from their perspective is essential to initiate an effective treatment plan.

The Provision of Spiritual Care by Registered Nurses on a Maternal—Infant Unit

Purpose: This study explores the spirituality, spiritual well-being (SWB), and spiritual care provision of registered nurses on a maternal—infant unit. Methods: Data collection instruments included a demographic and spiritual care form, Spiritual Perspective Scale (SPS), and Spiritual Well-Being Scale (SWBS) to address the study's research questions. Findings: Significant positive correlations were found between SPS and SWBS as well as religious well-being (RWB) and existential well-being (EWB; subscales of SWBS). Religious attendance was significantly correlated with SPS, SWBS, and RWB but not EWB. Frequency of spiritual assessment themes was first encounter and when needed, whereas reaching up and reaching out described their provision of spiritual care. Conclusion: The sample was highly spiritual, spiritually well, and provided varied spiritual care. Implications: More spiritual care research is needed. Content on providing spiritual care must be enhanced within nursing curriculums as well as with nurses in practice.

Spirituality

The purpose of this study was to describe how spirituality affected the lives of African American mothers with Human Immunodeficiency Virus (HIV) in the context of coping. This qualitative descriptive study used secondary data of interviews from a larger longitudinal study of parental caregiving of infants seropositive for HIV. Participants were 38 African American mothers with HIV. Data from longitudinal semi-structured interviews were analyzed using content analysis. The women dealt with the stresses of HIV through a relationship with God. Two domains explain this relationship: God in control and God requires participation. The benefits of their relationship with God were a decrease in stress and worry about their own health and that of their infants. It is important for nurses working with mothers with HIV to acknowledge their spirituality and assess how spirituality helps them cope with and manage their illness.

Spiritual practice: a literature review related to spiritual health and health outcomes

Spirituality and the expression of spirituality have received renewed interest in both nursing and nonnursing literature over the last 20 years. Scholars in spirituality studies have contributed to the wealth of both qualitative and quantitative data that exist. Spiritual practices that facilitate spiritual health are embedded within many nursing interventions. The purpose of this review is to provide an overview of empirical and associated nursing literature on spiritual practices. Definitions of spirituality and spiritual health are included, and theoretical underpinnings of the empirical literature are discussed. Relation of spiritual practice as a health behavior is presented with implications for future research identified.

Women Undergoing Breast Diagnostics: The Lived Experience of Spirituality

PURPOSE/OBJECTIVES

To explore perceptions of spirituality in women who had undergone a breast diagnostic experience.

RESEARCH APPROACH

Qualitative, phenomenologic study using Giorgi's approach.

SETTING

An outpatient comprehensive breast assessment center.

PARTICIPANTS

20 Caucasian women, aged 30-89, who had just completed the diagnostic process, including definitive diagnosis, regarding a breast abnormality.

METHODOLOGIC APPROACH

In-depth, semistructured, tape-recorded, and transcribed interviews analyzed using the Giorgi method of coding, transforming, and synthesizing data.

MAIN RESEARCH VARIABLES

Descriptions of spirituality, spiritual needs, and supporting spirituality.

FINDINGS

Two themes emerged: creating a focused isolation and seeking connections. Women created a private mental world in which to concentrate on the stressful diagnostic process. Within the isolation, women explored their personal strength and their connection to God or their spiritual beliefs. When the stress began to overwhelm, they sought out loved ones for support and diversion. Women found the center's staff to be supportive; however, many did not wish to speak to an agency chaplain during the uncertain period.

CONCLUSIONS

Women needed to handle the stress alone, with reliance on spirituality and God that was balanced with a need for specific connections to family members or close friends.

INTERPRETATION

Nurses can support women's need to focus and can assist family members to understand their role during the diagnostic period. The diagnostic period can be used to talk with women about their spiritual beliefs, their needs, and possible referral to a chaplain.

Psychometric characteristics of the spiritual perspective scale in pregnant African-American women

In health disparities research, studying the vulnerabilities of African Americans should be balanced by research on resources and strengths that influence health. One resource is spirituality, yet few tools have been developed and tested in diverse populations. This study evaluated the psychometric characteristics of the Spiritual Perspective Scale (SPS) in 102 pregnant African American women. Internal consistency reliability was high and evidence of construct validity was provided. The SPS correlated as hypothesized with church attendance, religiosity, and self-reported spirituality. In addition, the SPS correlated negatively with depression, anxiety, and stress. Factor analysis revealed a two-factor solution. The SPS performed well suggesting that it is an appropriate tool to use as a measure of spirituality in pregnant African American women.

African Americans and diabetes: Spiritual role of the health care provider in self-management

How African Americans with type 2 diabetes perceive the spiritual role of health care providers (HCPs) and the effects of that role on self-management was explored using a qualitative descriptive analysis. The sample consisted of 29 African American men and women ages 40-75 with type 2 diabetes and 5 ministers of African American churches. A spiritual relationship with their health provider was important in helping participants manage their diabetes. Three typologies from a parent study were expanded with a focus in this extended study on the meaning ascribed to spiritual relationships with providers and the impact of these relationships on self-management. Care perceived as spiritual may be an important component of providing culturally sensitive health care to African Americans and may facilitate their self-management.

Prayer as a complementary health strategy for managing HIV-related symptoms among ethnically diverse patients

Data were analyzed from an ethnically diverse convenience sample comprising 1071 adults participating in a multisite study. Older African Americans, Hispanics, and females were more likely to use prayer as a complementary health strategy for HIV-related anxiety, depression, fatigue, and nausea. Implications for future studies are discussed.

Spiritual experiences of parents and caregivers who have children with disabilities or special needs

Despite the fact that faith has been described as a universal concern, and despite the realization that the presence of social supports is an essential element in successful coping, there has been no systematic examination of the quality of spiritual networks important to families impacted by childhood disability. There is also little understanding of how spirituality in children influences the lived experience of faith in the adults who care for them. Findings reported here come out of a larger existential phenomenology study that examined the lived experience of parents or caregivers who sought to obtain formal religious education for their children with special needs. Participants included 26 parents/caregivers representing 44 children with special needs and 15 different faith traditions. Narratives indicated that many clergy and members of faith communities either devalue or fail to recognize the spiritual lives of disabled children. This lack of recognition was associated with participant disillusionment or crises of faith and a sense of alienation from potential sources of emotional support. In contrast, those participants whose children were welcomed reported feeling sustaining support and strengthened faith. No parent or caregiver perceived nurses as having an awareness of or interest in spirituality within families of children who have special needs.

Assessing a patient's spiritual needs: a comprehensive instrument

Seven major constructs-belonging, meaning, hope, the sacred, morality, beauty, and acceptance of dying-were revealed in an analysis of the literature pertaining to patient spiritual needs. The authors embedded these constructs within a 29-item survey designed to be inclusive of traditional religion, as well as non-institutional-based spirituality. This article describes the development of a multidimensional instrument designed to assess a patient's spiritual needs. This framework for understanding a patient's spiritual needs hopefully contributes to the growing body of literature, providing direction to healthcare professionals interested in a more holistic approach to patient well-being.